This invention relates to a method of performing minimally invasive surgery, and to surgical instruments adapted for use performing such surgery.
Laparoscopic surgical techniques have greatly reduced the trauma and recovery time associated with many kinds of surgery. In a typical laparoscopic surgery, a small incision is made at the umbilicus for the introduction of a small video camera. The abdomen is inflated with carbon dioxide. One or more punctures are made through the abdomen wall for the introduction of surgical instruments through the abdomen wall. Although design refinements have made these instruments compact, the punctures required are still relatively large, ranging from about 15 to about 100 french (about 5 to about 30 mm or about 0.197 to about 1.179 inches). While relatively small, these punctures are traumatic to the patient, and take considerable time to heal properly. In view of the size of laparoscopic instruments heretofore available, laparoscopic techniques generally cannot be used for many types of thoracic surgery because the instruments cannot pass through the small inter-rib spacing.
Generally the method of conducting minimally invasive surgery according to the present invention comprises the steps of: making a primary incision; importing at least one surgical instrument head through the primary incision; making at least one secondary incision, smaller than the primary incision and smaller than the cross-section of the surgical instrument head, for the introduction of a handle into the body; extending the distal end of the handle through the secondary incision; and attaching one of the surgical instrument heads to the distal end of the handle inside the body. The surgical instrument head is then manipulated inside the body by the handle to which it is attached. The surgical instrument head is then detached from the handle, and eventually removed from the body through the primary incision. The distal end of the handle is simply withdrawn from the secondary incision.
The handle can provide mechanical, pneumatic, or hydraulic pressure or electric or optical power to the surgical instrument head mounted on its distal end. Of course, more than one surgical instrument head can be imported through the primary incision, and multiple handles can be used so that more than one surgical instrument head can be used at a time. Moreover, providing multiple surgical instrument heads allows the surgical instrument heads to be changed as the surgery progresses, for example allowing a cutting surgical instrument head to be replaced with a suturing surgical instrument head.
The primary incision is preferably made through the umbilicus, but could also be made through the super pubic region or other discrete entry site on the body to minimize visible scarring. Because the secondary incisions do not have to pass the surgical instrument heads, the secondary incisions can be made very small, minimizing injury and pain to the patient, and subsequent visible scarring. Also, because of their small size, the secondary incisions can be made through the patient's rib cage, between the ribs, for conducting thoracic surgical procedures, allowing the surgical instrument heads to be manipulated with handles extending between the patient's ribs. If desired, the secondary incisions could be made from the inside out, by using the surgical instrument heads imported through the primary incision.
According to the method of this invention, surgery can be conducted with a single primary incision. The secondary incisions for the handles can be of the size of medium size needles. Thus the trauma and discomfort to the patient is substantially reduced, and the recovery time is shortened. Patients will suffer less post-operative pain, and will be able to return home sooner. Moreover, since the primary incision can be located in the umbilicus, or other discrete site there will be little if any visible scarring.
These and other features and advantages will be in part apparent, and in part pointed out hereinafter.